目的 探究维持性血液透析（MHD）患者的病耻感现状,并对其影响因素进行分析。方法 根据便利抽样法,选取2020年2月—2022月10月在河南省郑州市第三人民医院血液净化中心进行MHD治疗的236例患者作为研究对象,并采用一般资料调查问卷、领悟社会支持量表（PSSS）以及社会影响量表（SIS）进行调查。根据SIS得分情况进行分组,采用Logistic回归分析行MHD患者病耻感的影响因素。结果 MHD患者病耻感得分为（65.03±10.68）分,其中病程较短、社会支持度低、家庭平均收入低、文化水平较低以及未参加肾友会的患者病耻感得分较高,病程较长、家庭平均收入高、社会支持度高、参加肾友会以及文化水平较高者病耻感得分较低（P<0.05）。多因素Logistic回归分析结果显示,患者文化水平、家庭平均收入、是否参加肾友会、病程以及社会支持情况是患者病耻感的影响因素（P<0.05）。结论 MHD患者病耻感得分处于中高等水平。指导患者正确认识疾病,多关注家庭收入较低患者,鼓励患者积极参与肾友会,为患者提供良好的社会支持,均有助于降低其病耻感程度。

Objective To explore the current status of shame in maintenance hemodialysis（MHD）patients and analyze its influencing factors．Methods Based on the convenience sampling method,236 patients who underwent MHD treatment at the Blood Purification Center of the Third People’s Hospital of Zhengzhou City,Henan Province from February 2020 to October 2022 were selected as the research subjects．A general information survey questionnaire,Perceived Social Support Scale（PSSS）,and Social Impact Scale（SIS）were used for the survey．Grouping based on SIS scores,logistic regression analysis was used to analyze the influencing factors of shame in MHD patients．Results MHD patients had a shame score of（65.03±10.68）,among which patients with shorter disease course,lower social support,lower average family income,lower education level,and those who did not participate in kidney friend associations had higher shame scores．Patients with longer disease course,higher average family income,higher social support,participation in kidney self-help group,and higher education level had lower shame scores（P<0.05）．The results of multivariate logistic regression analysis showed that the patient’s educational level,average family income,participation in a kidney self-help group,course of illness,and social support were the influencing factors for the patient’s sense of shame（P<0.05）．Conclusions The shame score of MHD patients is at a moderate high level．Guiding patients to have a correct understanding of the disease,paying more attention to patients with lower family income,encouraging them to actively participate in kidney self-help group,and providing good social support to patients can all help reduce their sense of shame．

谨慎处理报告的抗生素过敏是抗生素管理的一个重要方面。荷兰抗生素政策工作组（SWAB）于2023年4月发布了《SWAB指南：疑似抗生素过敏的处理方法》以下简称（指南）,指南依据对疑似抗生素过敏人群的比较和结果问题研究,对每个问题进行系统的文献检索,并通过证据评价系统对现有最佳证据进行审查后制定。指南就疑似抗生素交叉过敏,速发型过敏和迟发型过敏等问题进行阐述,为报告抗生素过敏患者选用抗生素治疗的床旁决策提供基于现有研究的循证建议。本文对指南涉及12个关键问题进行解读,以期为疑似抗生素过敏患者临床治疗提供参考,使患者获益。

Careful handling of reported antibiotic allergies is an important aspect of antibiotic management．In April 2023,the Dutch Working Group on Antibiotic Policy（SWAB）issued the SWAB Guide：“The Dutch Working Party on Antibiotic Policy（SWAB）guideline for the approach to suspected antibiotic allergy”,hereinafter referred to as “the guide”．According to the intervention,comparison and results of people with suspected antibiotic allergy,the guide systematically searched the literature of each question,and was formulated after reviewing the best evidence available through the evidence evaluation system．The guide elaborated on the suspected cross-allergy,quick-onset allergy and delayed-onset allergy,and selected antibiotics for reporting patients with antibiotic allergy．In this paper,12 key issues involved in the guidelines are interpreted in order to provide reference for clinical treatment of patients suspected of antibiotic allergy and benefit patients．

目的 探讨远程药学管理模式联合延续护理在2型糖尿病（T2DM）合并冠状动脉病变患者居家用药中的应用效果。方法 选取2021年6月—2023年6月在广州医科大学附属第三医院诊治的200例T2DM合并冠状动脉病变患者为研究对象,根据干预方式不同分为常规组100例和研究组100例。常规组患者给予院内院外常规护理,研究组在常规组的基础上给予远程药学管理模式联合延续护理。评估患者用药依从性、饮食依从性、运动依从性、自我管理能力、生活质量[36条目简明健康量表（SF-36）]及心血管事件发生情况。结果 研究组用药、饮食、运动依从性均高于常规组（P<0.05）。相较于干预前,两组患者在干预后的自我管理机能、自我责任感、自我概念及健康知识分值均升高,且研究组高于常规组（P<0.05）。相较于干预前,两组患者在干预后的活力（VT）、精神健康（MH）、情感职能（RE）、躯体疼痛（BP）、生理功能（PF）、社会功能（SF）、生理职能（RP）、总体健康（GH）分值均升高,且研究组高于常规组（P<0.05）。研究组与常规组患者心血管不良事件发生率分别为2例（2.00%）、15例（15.09%）,研究组高于常规组（χ²=10.865,P<0.05）。结论 远程药学管理模式联合延续护理能够提高T2DM合并冠状动脉病变患者的用药管理依从性,提高患者自我管理能力,改善生活质量,降低不良心血管事件的发生率。

Objective To explore the application effect of remote pharmacy management mode combined with continuous nursing in the home medication of type 2 diabetes mellitus（T2DM）patients with coronary artery disease．Methods A total of 200 patients with T2DM complicated with coronary artery diseases who were diagnosed and treated in the Third Affiliated Hospital of Guangzhou Medical University from June 2021 to June 2023 were selected as the study subjects．They were divided into a conventional group of 100 patients and a study group of 100 patients based on different intervention methods．The patients in the conventional group received routine care both in and out of the hospital,while the study group received remote pharmaceutical management mode combined with continuous care on the basis of the conventional group．Patient medication compliance,dietary compliance,exercise compliance,self-management ability,quality of life[36 item concise health scale（SF-36）] and incidence of adverse cardiovascular events were assessed．Results The compliance of medication,diet and exercise in the study group were significantly higher than those in the conventional group（P<0.05）．Compared to before intervention,the self-management function,sense of responsibility,self-concept and health knowledge scores of both groups of patients were significantly increased after intervention,and the scores of the study group were significantly higher than those in the conventional group（P<0.05）．Compared to before intervention,the Vitality（VT）,Mental Health（MH）,Emotional Function（RE）,Physical Pain（BP）,Physiological Function（PF）,Social Function（SF）,Physiological Function（RP）and Overall Health（GH）scores of both groups of patients were significantly increased after intervention,and the scores of the study group was significantly higher than those of the conventional group（P<0.05）．The incidence of cardiovascular adverse events in the study group and the conventional group were 2 cases（2.00%）and 15 cases（15.09%）,respectively,with the study group significantly higher than the conventional group（χ²=10.865,P<0.05）．Conclusions The combination of remote pharmaceutical management mode and continuous care can significantly improve the medication management compliance of T2DM patients with coronary artery disease,improve their self-management ability,improve the quality of their life and reduce the incidence of adverse cardiovascular events．

目的 分析恩格列净对2型心肾综合征（CRS）患者的治疗效果。方法 研究于2021年10月—2023年10月进行,随机抽取88例2型CRS患者,经计算机程序随机分成对照组（44例,给予常规治疗）、实验组（44例,在常规治疗的同时加用恩格列净）,通过对比两组患者心、肾功能指标来评估疗效,并记录两组患者治疗过程中发生的不良反应。结果 治疗后,实验组LAD、LVED低于对照组,而LVEF高于对照组;实验组血清肌酐、尿酸等肾功能指标水平均低于对照组（均P<0.05）。两组不良反应发生率比较差异无统计学意义（P>0.05）。结论 对于2型CRS患者,恩格列净可促进其心、肾功能的改善,且无过多不良反应,安全性理想,治疗效果可观,值得推广。

Objective To analyze the therapeutic effect of empagliflozin on patients with type 2 cardiorenal syndrome（CRS）．Methods The study was conducted from October 2021 to October 2023,and 88 patients with type 2 CRS were randomly selected and divided into control group（44 cases,receiving conventional treatment）and experimental group（44 cases,receiving conventional treatment combined with englaglitzin）by computer program．The efficacy was evaluated by comparing cardiac and renal function indexes and adverse reactions．Results After treatment,the LAD and LVED of the experimental group were lower than those of the control group,while LVEF was higher than that of the control group．The levels of serum creatinine,uric acid and other renal function indexes in the experimental group were lower than those in the control group after treatment（P<0.05）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions For patients with type 2 CRS,empagliflozin can promote the improvement of cardiac and renal function without many side effects,with ideal safety and considerable therapeutic effect,which is worthy of promotion．

目的 检测微小RNA（miR）在人黑色素瘤中的表达情况,研究miR-412通过抑制性别确定区Y框转录因子6（SOX6）的表达影响黑色素瘤细胞增殖及侵袭能力的变化。方法 癌症基因组图谱（TCGA）数据库分析发现miR-412在黑色素瘤中异常表达,为研究其表达与肿瘤的相关性,采用Transwell小室,非锚定独立生长实验分析miR-412对黑色素瘤细胞增殖及侵袭能力的影响。软件预测SOX6可能为其靶向基因,采用荧光素酶报告分析及Western blot实验检测SOX6与miR-412的靶向调节情况。结果 TCGA数据库分析黑色素瘤组织中miR-412表达水平高于正常对照组,表达越高,生存时间越短。Transwell小室,非锚定独立生长实验显示miR-412过表达后促进细胞增殖及侵袭能力,而下调miR-412后抑制黑色素瘤细胞增殖及侵袭能力;通过靶点预测miR-412结合SOX6基因3’-非翻译区（UTR）,导致SOX6蛋白因miR-412表达增高而下调;同时在miR-412下调的细胞中抑制SOX6表达可恢复黑色素瘤细胞的增殖及侵袭能力。结论 miR-412过表达后促进黑色素瘤细胞增殖及侵袭能力,反之则抑制黑色素瘤细胞增殖及侵袭能力。 miR-412通过靶向调控SOX6影响黑色素瘤细胞增殖及侵袭,提示miR-412在黑色素瘤的发病过程中起重要作用,是潜在的治疗靶点。

Objective To assess the expression of miR-412 in human melanoma and investigate how miR-412 modulates melanoma cell proliferation and invasive capacity by inhibiting SRY-Box Transcription Factor 6,（SOX6） expression．Methods Analysis of the TCGA（The Cancer Genome Atlas）database identified aberrant miR-412 expression in melanoma．To explore its relevance to tumorigenesis,we conducted Transwell chamber and non-adherent independent growth assays to examine the effects of miR-412 on melanoma cell proliferation and invasion．Software predictions highlighted SOX6 as a potential target gene．We performed luciferase reporter assays and Western blot experiments to elucidate the regulatory interactions between SOX6 and miR-412．Results TCGA database analysis revealed significantly elevated miR-412 expression levels in melanoma tissues compared to the normal control group．Moreover,higher miR-412 expression correlated with shorter survival times．Functional assays using Transwell chambers and non-adherent independent growth assays demonstrated that overexpressing miR-412 enhanced cell proliferation and invasive capabilities．Conversely,reducing miR-412 expression restrained these attributes in melanoma cells． Target prediction analysis indicated that miR-412 binds to the 3’-UTR region of SOX6,resulting in decreased SOX6 protein levels due to increased miR-412 expression．Intriguingly,inhibiting SOX6 expression concurrently amplified the proliferation and invasive potential of melanoma cells,which was initially dampened by miR-412 downregulation．Conclusions Elevated miR-412 expression augments melanoma cell proliferation and invasive capabilities,while its suppression diminishes these traits．Through its targeted regulation of SOX6,miR-412 exerts a significant influence on melanoma cell proliferation and invasion．These findings underscore the pivotal role of miR-412 in melanoma pathogenesis and underscore its potential as a promising therapeutic target．

目的 分析音乐治疗焦虑领域研究热点的演变与趋势。方法 利用文献计量学方法对近20年（2003——2023）发表音乐治疗焦虑方面的研究与文献进行了可视化分析：对中国知网（CNKI）及Web of Science（WOS）文献库中收录的文献进行关键词（中文关键词：音乐治疗、焦虑;英文关键词：Music therapy、Anxiety）检索,利用CiteSpace 6.3 R2软件绘制知识图谱进行可视化分析。结果 通过文献的检索与筛选最终纳入中文文献506篇及英文文献1 782篇,其中国内外主要发文者为刘月芳、刘春艳、Bradt、Cold、Silverman等研究者团队,国内外主要研究机构均为高校,但国内高校相对于国外相关研究开展较为独立且合作联系较少;发文国家主要为美国、中国以及土耳其,西方国家之间的合作联系较为密切,我国开展相关跨地域研究主要是与亚洲国家进行多中心合作。国内研究热点为“音乐疗法”“心理干预”“五行音乐”等,国外研究热点为“Pain”“Depression”“Quality of life”等。结论 本文通过CiteSpace软件进行文献计量学分析发现,音乐治疗与焦虑结合是国内外研究的热点,国内研究聚焦于焦虑,而国外研究更关注音乐治疗在广泛心理问题中的应用。尽管该研究领域发展迅速,但国内外合作交流较少,国际研究团队间合作不够紧密。未来研究需进一步探索音乐治疗的机制和最佳实践方法,加强跨学科合作,利用科技创新,结合中国文化特色,以期实现音乐治疗在焦虑治疗中的更广泛应用,并提升患者的生活质量。同时,未来相关研究方法需多样化,以全面掌握研究趋势,为音乐治疗焦虑提供更有力的证据支持。

Objective To explore the evolution and trends of research hotspots in the field of music therapy for anxiety and provide reference and basis for related research．Methods Bibliometric analysis method was used to visualize and analyze the research and literature on music therapy for anxiety in the past 20 years（2003-2023）．Keyword searches were conducted in Chinese National Knowledge Infrastructure（CNKI）and Web of Science（WOS）databases,and a knowledge map was drawn using CiteSpace 6.3 R2 software for visualization analysis．Results Through the literature search and screening,506 Chinese and 1782 English literatures were included,and the main authors at home and abroad were researcher teams such as Liu Yuefang,Liu Chunyan,Bradt,Cold and Silverman．The main research institutions at home and abroad were universities,but domestic universities were more independent and had fewer collaborative relationships than foreign ones．The main publishing countries were the United States,China and Turkey,and there was closer cooperation between western countries．Multicenter cooperation with Asian countries was the main form of cross-region research in China．The research hotspots at home were “music therapy”,“psychological intervention”,“five elements music”,while the foreign research hotspots were “pain”,“depression”,and “quality of life”．Conclusions The combination of “music therapy” and “anxiety” is the main research hotspot at home and abroad in recent years．Among them,foreign scholars mainly use anxiety and other psychological problems as research topics to explore the application of music therapy to these issues,while domestic scholars focus on the research of anxiety and propose many music therapy programs for anxiety．In addition,there is relatively little cooperation and communication between domestic and foreign research sectors,and the degree of coincidence among international research teams is not high．Therefore,research teams at home and abroad should strengthen cooperation and communication．Based on the analysis of research hotspots in music therapy for anxiety in the past 20 years,this field has received considerable attention and has developed rapidly,but there are still many aspects that need to be explored and improved through continuous efforts and innovation．

目的 探讨微RNA-29b（miR-29b）对子宫内膜癌细胞增殖、迁移和侵袭的影响。方法 子宫内膜癌HEC-1-B细胞分为miR-29b模拟物组（MM组）、miR-29b阻遏物组（MR组）和阴性对照物组（MNC组）,分别转染miR-29b拟似物、miR-29b阻遏物和miR-29b阴性对照物,每组设置6个复孔。以实时定量逆转录PCR检测miR-29b表达,以水溶性四氮唑（WST-1）检测miR-29b对HEC-1-B子宫内膜癌细胞增殖的影响,以Transwell小室检测HEC-1-B子宫内膜癌细胞迁移和侵袭的影响,以Western blot法检测磷酸酶张力蛋白同源物（PTEN）-蛋白激酶 B（AKT）通路蛋白表达水平。结果 MNC组、MM组、MR组miR-29b相对表达量分别为（2 032.1±873.4）、（19 272.8±2 087.9）、（472.7±105.6）,组间比较差异有统计学意义（P<0.05）。MM组0、3、5、7 d时OD值分别为（0.32±0.06）、（0.53±0.08）、（1.13±0.12）和（1.92±0.14）,MNC组0、3、5、7 d时OD值分别为（0.34±0.09）、（0.71±0.08）、（1.67±0.21）和（3.49±0.24）,MR组0、3、5、7 d时OD值分别为（0.38±0.09）、（0.84±0.18）、（2.43±0.24）和（5.67±0.15）,3组0 d时OD值比较差异无统计学意义（P=0.216）,三组3 d、5 d、7 d时OD值比较差异存在统计学意义（P<0.001）。MNC组、MM组和MR组迁移细胞数分别为（403.9±23.8）（102.6±15.7）和（685.7±46.8）个,上述3组侵袭细胞数分别为（82.1±12.7）（38.2±10.6）和（124.6±21.6）个,MM组和MNC组上述指标比较差异均有统计学意义（P<0.05）,MR组和MM组上述指标比较差异均有统计学意义（P<0.05）。MNC组、MM组、MR组PTEN蛋白相对表达量分别为（0.25±0.08）、（0.69±0.11）、（0.11±0.05）,上述3组p-AKT蛋白相对表达量分别为（0.58±0.10）、（0.13±0.06）和（0.79±0.08）,上述3组AKT蛋白相对表达量分别为（0.38±0.09）、（0.37±0.11）和（0.37±0.08）,MM组与MNC组PTEN、p-AKT水平比较差异有统计学意义（P<0.05）,AKT水平比较差异无统计学意义（P>0.05）;MR组与MNC组、MM组PTEN、p-AKT水平比较差异有统计学意义（P<0.05）,AKT水平比较差异无统计学意义（P>0.05）。结论 过表达miR-29b对子宫内膜癌细胞增殖、迁移和侵袭具有抑制作用,靶向PTEN-AKT可能是其重要作用途径。

Objective To investigate the effects of microRNA-29b on proliferation,migration and invasion of endometrial cancer cells．Methods The endometrial cancer HEC-1-B cells were divided into micro29b mimetic group（MM group）,micro29b repressor group（MR group）and negative control group（MNC group）,and the micro29b mimetic,micro29b repressor and micro29b negative control were transfected into each group,six compound holes with each group．The real-time quantitative reverse transcription polymerase chain reaction（RT-PCR）was used to detect the expression of mi29b,WST-1 was used to detect the effect of mi29b on the proliferation of HEC-1-B endometrial cancer cells,Transwell chamber was used to detect the migration and invasion of HEC-1-B endometrial cancer cells,and Western blot was used to detect the expression level of PTEN-AKT pathway protein．Results The relative expression levels of microRNA-29b in MNC group,MM group and MR group were（2 032.1±873.4）,（19 272.8±2 087.9）and（472.7±105.6）,respectively,and there were significant differences between groups（P<0.05）．OD values of MM group at 0 d,3 d,5 d and 7 d were（0.32±0.06）,（0.53±0.08）,（1.13±0.12）and（1.92±0.14）respectively．The OD values of MNC group at 0,3,5 and 7 days were（0.34±0.09）,（0.71±0.08）,（1.67±0.21）and（3.49±0.24）respectively．The OD values of MR group at 0 d,3 d,5 d and 7 d were（0.38±0.09）,（0.84±0.18）,（2.43±0.24）and（5.67±0.15）respectively．There was no significant difference in OD value between the three groups on day 0 （P=0.216）．There were significant differences in OD value between the three groups on day 3,day 5 and day 7（P<0.001）．The number of migrating cells in MNC group,MM group and MR group were（403.9±23.8）cells,（102.6±15.7）cells and（685.7±46.8）cells,respectively．The number of invasive cells in the above three groups were（82.1±12.7）cells,（38.2±10.6）cells and（124.6±21.6）cells．There were significant differences in the above indexes between MM group and MNC group（P<0.05）,also between MR group and MM group（P<0.05）．The relative expression levels of PTEN protein in MNC group,MM group and MR group were（0.25±0.08）,（0.69±0.11）and（0.11±0.05）．The relative expression levels of p-AKT protein in the above three groups were（0.58±0.10）,（0.13±0.06）and（0.79±0.08）．The relative expression levels of AKT protein in the above three groups were（0.38±0.09）,（0.37±0.11）and（0.37±0.08）,respectively．Compared with MNC group,the levels of PTEN and p-AKT in MM group had statistical significance（P<0.05）,but there was no statistical difference in AKT level（P>0.05）．Compared with MNC group and MM group,the levels of PTEN and p-AKT in MR group had statistical significance（P<0.05）,and there was no statistical difference in AKT level（P>0.05）．Conclusions Overexpression of microRNA-29b can inhibit the proliferation,migration and invasion of endometrial cancer cells,and targeting PTEN-AKT may be an important pathway．

目的 分析神经系统副肿瘤综合征（PNS）的临床特点以提高对该病的早期诊断和治疗效果。方法 回顾性分析惠州市第一人民医院和惠州市中心人民医院神经内科2019年10月—2022年10月收治的21例PNS患者的临床表现、实验室检查结果和治疗效果,并作文献回顾。结果 21例患者中出现了10种副肿瘤综合征,其中经典综合征占比28.6%（6/21）,最多见的是边缘叶脑炎;20例在血液或脑脊液中发现检测到抗神经元抗体,非特征性抗体阳性率最高（12/20）,其中以半定量脑组织切片TBA检测阳性率最高（7/20）;有特征性抗体的8例以抗Yo抗体阳性率最高（6/8）。21例患者均随访至2023年3月,8例发现原发肿瘤,其中4例在神经系统病变之后。69.25%（9/13）的患者使用糖皮质激素治疗和（或）丙种球蛋白治疗有效。结论 21例PNS患者中以非经典综合征占比较多,经典与非经典副肿瘤综合征均应进行肿瘤筛查,未发现肿瘤者应密切随访。非特征性抗体阳性率最高,提示PNS可能仍有许多相关抗体未明确,临床工作中也应对非特征性抗体阳性予以重视。

Objective To analyze the clinical features of paraneoplastic neurological syndrome（PNS）to improve the early diagnosis and treatment of this disease. Methods The clinical manifestations,laboratory results and treatment effects of 21 patients with PNS admitted to Huizhou First People's Hospital and Huizhou Central People's Hospital from October 2019 to October 2022 were retrospectively analyzed,and literature review was performed. Results There were 10 paraneoplastic syndromes in 21 patients,of which classical syndrome accounted for 28.6%（6/21）,the most common was limbic lobe encephalitis．Anti-neuronal antibodies were detected in blood or cerebrospinal fluid in 20 cases,with the highest positive rate of non-characteristic antibodies（12/20）,among which the positive rate of TBA detection by semi-quantitative brain tissue sections was the highest（7/20）;Eight cases with characteristic antibodies had the highest positive rate of anti-Yo antibody（6/8）．All 21 patients have been followed up so far,and 8 cases have found primary tumors,4 of which were after neurological lesions．There was 69.25%（9/13）of patients responded to hormone therapy or（and）gamma globulin therapy. Conclusions Non-classical syndrome accounts for more patients with PNS,and both classical and non-classical paraneoplastic syndromes should be screened for tumors,and those who have not found tumors should be closely followed．The positive rate of non-characteristic antibodies is the highest,indicating that there may still be many related antibodies in PNS that are not clear,and the positive of non-characteristic antibodies should also be paid attention to in clinical work．

目的 探究25-羟维生素D[25-（OH）D]水平预测糖尿病周围神经病变发生的相关性。方法 选取2021年6月—2021年12月间在上海市静安区南京西路社区卫生服务中心就诊的200例2型糖尿病患者为研究对象,根据体格检查、血液生化、神经症状评分、肌电图等方法分为无周围神经病变组（n=153）和周围神经病变组（n=47）,对比两组患者的一般资料及血清基线25-（OH）D水平,分析25-（OH）D与糖尿病周围神经病变的相关性,采用Logistic回归分析25-（OH）D对糖尿病周围神经病变的预测价值。结果 两组患者基线25-（OH）D水平、空腹血糖、糖化血红蛋白（HbA_1c）、收缩压对比差异有统计学意义（P<0.001）,而年龄、性别、BMI、腰围、餐后血糖值、谷草转氨酶、空腹C肽、总胆固醇、高密度脂蛋白胆固醇、甘油三酯、低密度脂蛋白胆固醇（LDL-C）、血肌酐、血尿酸、舒张压对比无明显差异（P>0.05）;基线25-（OH）D水平与密歇根糖尿病周围神经病变评分（MDNS）呈负相关（r=-0.583,P<0.001）,空腹血糖与MDNS评分呈正相关（r=0.303,P<0.001）;Logistic回归分析提示,25-（OH）D每增加一个单位,糖尿病周围神经病变风险下降25%,校正性别、年龄、HbA_1c、LDL后,相关性依然存在。结论 25-（OH）D水平与糖尿病周围神经病变呈负相关,与该病的发生及发展密切相关,血清25-（OH）D水平可作为预测尿病周围神经病变发生、发展的重要指标。

Objective To explore the correlation of 25-hydroxyvitamin D[25-（OH）D] level in predicting the occurrence of diabetic peripheral neuropathy．Methods A total of 200 patients with type 2 diabetes mellitus（T2DM）who were admitted to Community Health Service Center of West Nanjing Road,Jing’an District,Shanghai from June 2021 and December 2021 were selected as the study subjects．According to physical examination,blood biochemistry,neurological symptom score and electromyography,the patients were divided into two groups：no peripheral neuropathy group（n=153）and peripheral neuropathy group（n=47）．The general data and serum baseline 25-（OH）D levels of the two groups were compared to analyze the correlation between 25-（OH）D and diabetic peripheral neuropathy．The predictive value of 25-（OH）D in diabetic peripheral neuropathy was analyzed by Logistic regression．Results There were significant differences in baseline 25-（OH）D level,fasting blood glucose（FBG）,HbA_1c and SBP between two groups（P<0.001）,but no significant differences in age,sex,BMI,waist circumference,postprandial plasma glucose,AST,C-peptid total cholesterol,HDL-C,triglyceride,LDL-C,Scr,UA and DBP between two groups（P>0.05）．Baseline 25-（OH）D level was negatively correlated with MDNS score（r=-0.583,P<0.001）,and FBG was positively correlated with MDNS score（r=0.303,P<0.001）．Logistic regression analysis showed that the DPN risk decreased by 25% for every unit increase of 25-（OH）D,and the correlation remained after timely adjustment for sex,age,HbA_1c,and LDL-C．Conclusion sThe level of 25-（OH）D is negatively correlated with the occurrence and development of diabetic peripheral neuropathy,and the detection of serum 25-（OH）D level can be used as an important indicator to predict the occurrence and development of urinary peripheral neuropathy．

目的 探讨血清胱抑素C（Cys-C）联合β₂-微球蛋白（β₂-MG）早期诊断糖尿病肾病的应用价值。方法 选择2021年4月—2023年4月医院接收的100例糖尿病患者为对象,根据其有无合并肾脏疾病,将其分为糖尿病组及糖尿病肾病组,各50例,同比例选取同期到我院体检的健康人群50名进行对照研究,检测比较其Cys-C及β₂-MG水平,对比其Cys-C阳性率、β2-MG阳性率及联合检测阳性率,并对比不同疾病分期糖尿病肾病患者的Cys-C、β₂-MG水平。结果 糖尿病肾病患者Cys-C、β₂-MG水平高于糖尿病患者与健康者（P<0.05）。糖尿病患者Cys-C、β₂-MG水平高于健康者（P<0.05）。糖尿病肾病患者Cys-C阳性率64.00%、β₂-MG阳性率72.00%、Cys-C+β₂-MG联合检测阳性率96.00%高于糖尿病6.00%、10.00%、12.00%及健康者0.00%、0.00%、0.00%（P<0.05）;糖尿病Cys-C+β₂-MG联合检测阳性率12.00%高于健康者0.00%（P<0.05）;糖尿病肾病中Cys-C+β₂-MG联合检测阳性率96.00%高于CysC 64.00%、β₂-MG 72.00%（P<0.05）。糖尿病肾病不同分期患者Cys-C、β₂-MG水平比较,Ⅳ期>Ⅲ期>Ⅰ~Ⅱ期（P<0.05）。结论 糖尿病肾病患者Cys-C、β₂-MG水平明显升高,Cys-C、β₂-MG联合诊断更具有优势,而且肾损害越严重,Cys-C、β₂-MG异常程度越高,作为临床诊治的参考依据的价值较高。

Objective To investigate the application value of serum cystatin C（Cys-C）combined with β₂-microglobulin（β₂-MG）in the early diagnosis of diabetic nephropathy．Methods A total of 100 diabetic patients admitted to our hospital from April 2021 to April 2023 were selected as subjects,and divided into diabetes group and diabetic nephropathy group according to whether they have renal diseases or not,with 50 cases in each group．Then,50 healthy people who came to our hospital for physical examination in the same period were selected for comparative study,and their Cys-C and β₂-MG levels were detected and compared,and their Cys-C positive rate,β₂-MG positive rate and combined detection positive rate were compared．Results The levels of Cys-C and β₂-MG in patients with diabetic nephropathy were higher than those in patients with diabetes and healthy controls（P<0.05）．The levels of Cys-C and β₂-MG in diabetic patients were higher than those in healthy controls（P<0.05）．The positive rates of Cys-C（64.00%）,β₂-MG（72.00%）and Cys-C+β₂-MG（96.00%）in patients with diabetic nephropathy were higher than those in patients with diabetes（6.00%,10.00%,12.00%）and healthy subjects（0.00%,0.00%,0.00%）（P<0.05）．The positive rate of combined detection of Cys-C and β₂-MG in diabetic patients（12.00%）was higher than that in healthy subjects（0.00%）（P<0.05）．The positive rate of Cys-C combined with β₂-MG in diabetic nephropathy was 96.00%,which was higher than that of Cys-C 64.00% and β₂-MG 72.00%（P<0.05）．The levels of Cys-C and β₂-MG in patients with stage Ⅳ diabetic nephropathy were higher than those in patients with stage Ⅲ and Ⅰ-Ⅱ diabetic nephropathy（P<0.05）．The levels of Cys-C and β₂-MG in stage Ⅲ patients were higher than those in stage Ⅰ-Ⅱ patients（P<0.05）．Conclusions The levels of Cys-C and β₂-MG are significantly increased in patients with diabetic nephropathy,and the combination of Cys-C and β₂-MG has more advantages．The greater serious renal damage,the greater abnormal degree of Cys-C and β₂-MG,which has a higher value as a reference for clinical diagnosis and treatment．